Urgent: PPO vs EPO

Hey everyone, my open enrollment period closes this week. Historically I’ve always gone with a PPO, but this year I had some unanticipated medical expenses and got hit with 10% coinsurance for a number of procedures which really added up, so I’m trying to determine if I should be making a different choice. Here are the details:

  1. Both plans use the same network
  2. The PPO and EPO have the same premium
  3. The EPO has $0 deductible and $1500 out of pocket
  4. The PPO has $250 deductible and $3000 out of pocket
  5. All basic service costs are essentially the same, however, when it comes to things like advanced imaging (CT, MRI, etc), Ambulance, and Hospitalization (ie. The things that would inevitably be the most expensive) there’s 10% coinsurance for in-network services on the PPO, whereas on the EPO it’s a flat $50-200.

The EPO sounds like a no-brainer if I can stay in-network, and I don’t have any problem with doing that for 99.9% of my medical needs, BUT I’ve heard horror stories of people who are in an accident, or hospitalized, etc. and while the hospital is in-network, the attending physician(s) are not, which results in hundreds of thousands of dollars in medical debt, and inevitably, bankruptcy. How common or likely is this scenario? Am I getting worked up about nothing, or is the PPO the only way to protect myself?

Thanks for your help!

submitted by /u/cred_it
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Hey everyone, my open enrollment period closes this week. Historically I’ve always gone with a PPO, but this year I had some unanticipated medical expenses and got hit with 10% coinsurance for a number of procedures which really added up, so I’m trying to determine if I should be making a different choice. Here are the details:
Both plans use the same network The PPO and EPO have the same premium The EPO has $0 deductible and $1500 out of pocket The PPO has $250 deductible and $3000 out of pocket All basic service costs are essentially the same, however, when it comes to things like advanced imaging (CT, MRI, etc), Ambulance, and Hospitalization (ie. The things that would inevitably be the most expensive) there’s 10% coinsurance for in-network services on the PPO, whereas on the EPO it’s a flat $50-200.
The EPO sounds like a no-brainer if I can stay in-network, and I don’t have any problem with doing that for 99.9% of my medical needs, BUT I’ve heard horror stories of people who are in an accident, or hospitalized, etc. and while the hospital is in-network, the attending physician(s) are not, which results in hundreds of thousands of dollars in medical debt, and inevitably, bankruptcy. How common or likely is this scenario? Am I getting worked up about nothing, or is the PPO the only way to protect myself? Thanks for your help!
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